Archived: Bethany

Bethany is a purpose-built care home for up to 37 people. There are en suite bedrooms across three floors, shared living spaces and dining areas.

Each floor of the building is adapted to provide care for people with different levels of needs with one floor dedicated to providing care to people living with dementia. At the time of the inspection there were 31 people living in the home.

There is also a café, chapel and purpose-built bungalows on the site which are privately leased.

People’s experience of using this service and what we found

Bethany provided high-quality, person-centred care and support to people living there. The service had good measures in place to ensure people were safe. People’s risks were assessed and there were detailed support plans and measures in place to manage their risks. Medicines were managed safely and the home was clean and well maintained.

Care provided was in line with good practice and national guidelines. People were supported to achieve good outcomes and have a good quality of life. There were very positive relationships with other agencies and professionals to ensure people received joined-up, effective care. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People, their relatives and other professionals consistently told us of the outstanding, caring, patient and kind way in which staff supported people. People’s views and preferences were at the centre of their care and people were supported to have a voice in all aspects of their care decisions. The service was exceptionally respectful of people’s dignity and privacy and mindful of their emotional wellbeing.

People were supported in a way which met their needs, which reflected their individual choices and preferences, and which promoted their independence. People had access to a range of activities in the home and in their community, which reflected their cultural and spiritual needs, as well as their interests and preferences.

There was consistent, exceptionally strong leadership in the organisation and the home which drove a culture of continuous improvement and compassionate, person-centred care. People’s relatives and other professionals consistently reflected on their confidence in the leadership and management in the home and that people were at the heart of the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was good (published 22 October 2016). At this inspection we found the service had improved to outstanding.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Bethany is registered to provide care (without nursing) for up to 37 older people. The provider is a charitable organisation which focuses on providing people with a home which meets their spiritual needs as well as their physical and emotional well-being. Some people may be living with dementia or other conditions associated with the ageing process. There were 30 people resident on the day of the visit. The building offers accommodation over three floors in 30 single and seven double rooms. The double rooms were used to accommodate married couples or as single rooms. The second and third floors were accessed via staircases or a lift. The shared areas within the service were spacious and met the needs and wishes of people who live in the home.

The service has a registered manager running the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People were provided with exceptionally kind and compassionate care. Staff built very strong and caring relationships with people and their families and friends. People were treated with dignity and the greatest respect at all times. People’s beliefs and lifestyle choices were totally respected by a staff team that was fully committed to giving people individual care in the way they chose. People were provided with excellent support to help them to maintain or enhance their independence. The service was extremely good at giving compassionate end of life care.

People, visitors to the service and staff were kept safe, whilst in the service. Risks were identified and managed to make sure that people and others were kept as safe as possible. Staff were provided with training in the safeguarding of vulnerable adults and health and safety. They were able to describe how they kept people safe and were committed to protecting people in their care.

People were provided with safe care which was supported by adequate numbers of appropriately trained and skilled staff being available at all times. The service’s recruitment procedure ensured that as far as possible, all staff employed were suitable and safe to work with vulnerable people. People were given their medicines in the right amounts at the right times by staff who had been trained to carry out this task.

The management team and staff protected people’s rights to make their own decisions and consent to their care. The staff team understood the relevance of the Mental Capacity Act 2005, Deprivation of Liberty Safeguards (DoLS) and consent issues which related to the people in their care. The Mental Capacity Act 2005 legislation provides a legal framework that sets out how to act to support people who do not have capacity to make a specific decision. The service made DoLS applications to the appropriate authorities, as necessary.

People’s health, well- being and spiritual needs were met by staff who were properly trained and supported to do so. People were assisted to make sure they received health and well-being care from appropriate professionals. Staff were trained in specific areas so they could effectively meet people’s diverse and changing needs.

People benefitted from a very well-managed service. The registered manager and management team were described as very approachable. People views and comments were listened to and used as part of the quality assurance process. The service made sure they maintained and improved the quality of care provided.

We considered our inspection findings to answer questions we always ask;

Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

We found that people had been cared for safely. People's needs had been assessed and reflected in their care plans. Where necessary, assessments had been completed which identified and reduced risks to people, whilst supporting them to remain independent.

Where people needed support with more complex health needs we saw there were specific plans which detailed the care needed and how staff should provide this. We found that staff had received appropriate training in relation to meeting people's complex needs from health professionals, which had ensured that people's needs were met safely.

People who use the service said they felt safe with staff, who treated them with dignity and respect. One person said, 'The carers are marvellous. Sometimes I get lost and confused but they are always there to look after me.'

People had been protected from the risk of infection because appropriate guidance had been followed. We saw that infection control and prevention precautions had been rigorously implemented, including hand hygiene and the use of protective equipment. We found that all everyone had to sanitise their hands before entering the service to sign the visitor's book.

The service had ensured that people were protected from the risk of inappropriate or unsafe care. This was because the provider had an effective system to identify, assess and manage risks to the health, safety and welfare of people who use the service and others in relation to significant incidents.

People had only been deprived of their liberty in accordance with the law. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which apply to this service. The registered manager had made one DoLS application since the last CQC inspection, which had been appropriately notified to the CQC. We reviewed this application and found that the provider had followed the correct procedure.

Staff told us that they had received training about the implementation of the Mental Capacity Act 2005 (MCA). One senior team leader told, 'I have never worked anywhere where so much emphasis is placed on understanding dementia.' All staff demonstrated their knowledge of the five principles of the MCA and how they applied to the people they supported on an individual basis.

Is the service effective?

The service was effective because it placed people at the centre of all decisions regarding their care and support. Where the service had identified a person lacked capacity to make a decision, a best interest meeting had been held with people who knew and understood them, which ensured their human rights were protected. We noted that all advance decisions had been appropriately identified, recorded and had been respected by staff.

People had been protected from the risks of malnutrition and dehydration. The provider had identified where people were at risk of poor nutrition and hydration or had swallowing difficulties. We reviewed appropriate dietary plans for people with diabetes and those who required fortified or pureed meals.

Staff had received an effective induction programme recognised by the care sector, covering core subjects that included safeguarding, dementia awareness, the MCA 2005, infection control, management of medicines, food hygiene and moving and positioning.

We found that staff were knowledgeable about people's specific health and personal care needs and had received training to update their skills and knowledge. Staff had also received training to meet the specific needs of people. The provider had ensured that people received appropriate care from competent staff who had been supported in their professional development by an effective system of supervision and appraisal.

The palliative care specialist told us, "The palliative care provided here is on a par with that you would expect from a hospice."

Is the service caring?

People had been supported by kind and compassionate staff, who spoke to people in a friendly, caring manner. We saw that care workers gave encouragement to people who were able to do things at their own pace. One person told us 'The cook is like a mother hen. They always notice if we haven't eaten much and come to make sure we're alright.' A relative told us, 'This is a lovely care home, where caring and cheerful are staff willing to go the extra mile to give people really good care.'

We observed that staff supported people to make their own daily living choices and to be as independent as they were able to be. This promoted people's self-esteem and gave them a sense of achievement. The care staff we spoke with enjoyed working with people they supported. One care worker told us, "The residents are the most important thing to us. I find myself worrying about them even when I'm not at work.'

Since the last CQC inspection two people had written to us to share their positive experience of the service. One person wrote, 'An excellent home. As a health professional I have visited many care homes over the years and am very grateful that my parents were able to live their last years in such a well run, caring home.'

Is the service responsive?

The service was responsive to the changing needs of people and these had been continually reviewed. One person wished to see care staff more regularly but did not wish to become 'a nuisance' by ringing the call bell, despite being encouraged to do so. This person was happy because this request had immediately been incorporated into the person's care plan.

The manager told us that people were actively encouraged to share their ideas. For example a recent request to keep chickens, triggered by a visit to a local farm, had been posted in the provider's suggestion box. We saw the service had responded effectively to this suggestion by erecting a hen house and involving people with the upkeep of four hens.

We found that the service had swiftly identified when people's health had declined and had quickly responded by ensuring relevant health professionals had been consulted and short term specific care plans had been created and implemented.

Is the service well-led?

The service was well-led by an experienced registered manager and head of care. This had been evident during an outbreak of norovirus, when they had provided clear and direct leadership to staff, ensuring that effective infection control measures had been understood and implemented. People and relatives had been reassured by the confident and professional approach of the staff.

Care workers spoke positively and with pride about the service they provided for people, particularly in relation to dementia. Care staff told us, 'The manager is determined to provide the very best care possible for people at Bethany and we all know what is expected from us.'

The registered manager operated systems to deal with comments and complaints which had been understood by people, well-publicised and reflected principles of good complaint handling.

Observation of staff practices showed that people were receiving effective, safe and appropriate care, which was designed to meet their specific needs. The care provided was carried out with sensitivity and patience. People living in the home appeared happy, content and well cared for.

People we spoke with made positive comments about the staff and quality of their care. One person said, 'They treat me like their own family.' Another person's relative told us, 'He couldn't be happier anywhere else in the whole country."

We saw people being given their medicines in a safe and respectful way and noted how the senior team leader tactfully ensured that they had been swallowed.

We found people were cared for by suitably qualified, skilled and experienced staff because the provider had an effective recruitment and selection process.

The home had an effective complaints system, although there had been no formal complaints since the last inspection. The manager told us that people often did not want to make a fuss so they were encouraged to make suggestions for improvements with regular monthly surveys.